Lori J. Goldstein, MD, director, The Naomi and Phil Lippincott Breast Evaluation Center, co-leader, Breast Cancer Clinical Research Program, Fox Chase Cancer Center, discusses the role of fulvestrant (Faslodex) in the metastatic breast cancer setting.

Fulvestrant is a selective estrogen receptor down-regulator (SERD) that is equivalent to aromatase inhibitors in the second-line setting and anastrozole (Arimidex) in the first-line setting.

The Phase III CONFIRM trial compared fulvestrant at doses of 250 mg and 500 mg in order to discover the best dosing schedule. The result of the trial is a 500 mg dose administered on days 1, 14 and 28, followed by 500 mg every 28 days.

Long-term trials suggest that fulvestrant offers a superior time to progression over anastrozole in the first-line setting. The trial investigating this idea is still in early phases but does supply further choices for patients with metastatic estrogen receptor positive breast cancer.